American Association for Clinical Chemistry
Better health through laboratory medicine
October 2011 Clinical Laboratory News: TSH Not the Total Picture of Clinical Symptoms

AM 2011

The educational offerings at the AACC 2011 Annual Meeting were as diverse as the attendees. Symposia, workshops, brown bag sessions, and more gave attendees the latest information, as well as practical advice, on a myriad of clinical lab topics. Below is a brief on one of the sessions.

TSH Not the Total Picture of Clinical Symptoms

By Genna Rollins

Longevity medicine and the endocrine system were the subjects of a symposium on July 27. Blunting the effects of wear-and-tear, silent inflammation, and declines and imbalances in hormone levels is more of an issue now than ever before in our fast-based society, where the average lifespan is nearly double what it was at the turn of the last century, noted moderator and panelist Linda Rogers, PhD, DABCC, FACB, manager of market development at Beckman Coulter.

Panelist Rachel Dunn-Black, MD, an internist in private practice in Yreka, Calif., discussed the evolving science around thyroid hormones and how she works with patients to resolve thyroid imbalances. Although thyroid stimulating hormone (TSH) has been the gold standard for measuring thyroid function since the 1970s, in her experience, too many clinicians rely exclusively on TSH without assessing other pro (T4) or active (T3) forms of thyroid hormones. “I see a lot of patients who’ve already been told their TSH is fine. But in a lot of these patients, there’s not a correlation between their TSH number and their clinical symptoms,” she said. “There seems to be a disparity in a lot of patients between what the TSH level is and what the patient looks like. You can’t disconnect the two, and you can’t make your diagnosis based on a piece of paper.”

Rogers noted how toxic stress can be to the body. “Chronic stress leads to higher cortisol levels with the diurnal cycle blunted. But prolonged chronic stress eventually lowers cortisol levels, leading to adrenal hypofunction and fatigue, which has long-term deleterious effects,” she said. Like Dunn-Black, Rogers emphasized the need to consider lab results in the context of clinical symptoms, since hypothyroidism and adrenal fatigue often present similarly.

Panelist Nisha Jackson, PhD, WHCNP, MS, owner of Ventana Wellness in Medford, Ore., explained that hormones decline naturally with age, but imbalances that affect quality of life and disease risk are common. “If more practitioners were testing women’s hormone levels they would see that estrogen dominance is widespread and causes a variety of symptoms. Estrogen up-regulates breast and uterine tissues, while progesterone down-regulates them. So when estrogen dominates progesterone, you’ll have more stimulation of those tissues than you need.”